When your vehicle is damaged or stolen, one of the first things you should do is file an insurance claim. If another driver caused the damage to your vehicle, you have the option to file the claim either with your own insurance company, if you have the appropriate coverages (a "first party" claim), or with the insurer for the owner of the other car (a "third party claim").

In order for you to be able to file a "first party" claim, your policy must provide Collision or Comprehensive coverage (see right). These are often referred to as "Physical Damage" coverages.

Collision coverage protects you from damage caused to your car by a collision with another vehicle, a fixed object, or an object lying in the roadway. Collision coverage also protects you from damage caused by the upset of your vehicle.

Comprehensive coverage protects you if your car is stolen or vandalized or damaged by contact with an animal or falling objects (i.e., tree limbs, rocks, stones, debris). It also covers your vehicle for glass breakage, fire, wind, hail, and flood damage.

If you file a first party claim, your insurance company will either pay to repair the damages to your vehicle or pay you the value of your vehicle if the damages exceed the car's worth. First, though, the company will subtract the deductible amount you have chosen for that coverage.

If you file a third party claim against another driver, the other driver's insurance company will only pay for damages to your vehicle to the extent that their insured was legally responsible. In some instances, this may not be enough to reimburse you for the full amount of your loss. (More information on third party claims...)

1. Can I collect under "no-fault" insurance for damages to my vehicle if I was at fault for an accident and I do not carry first party coverage?

The answer is "NO". No-fault or Personal Injury Protection (PIP) insurance only pays for your own medical expenses if you are injured in an automobile accident, no matter who caused the accident. It does not pay for damage to a vehicle.

2. What must I do after a loss?

Immediately report all losses to your insurance agent or company.

Immediately report a loss to the police if your vehicle is stolen, vandalized, or damaged by a hit-and-run driver. Without a police report your company could deny your claim. In fact, under Division of Motor Vehicle law you are required to report any accident involving property damage in excess of $500.00 to the appropriate authorities.

You must make the damaged vehicle available for inspection by the insurance company before you have it repaired.

Protect your vehicle from further damage. If you don't do this, your insurer could refuse to pay for any subsequent damage. For example, if you don't cover a broken windshield and rain damages the upholstery, your company could refuse to pay for the damaged upholstery.

Cooperate with the insurance company's investigator. If you don't cooperate, the company could deny your claim.

When you file a first party claim, you have a direct contract with your insurer that requires the company to fulfill all the conditions stated in your policy. However, the contract also places duties and requirements on you, the insured, when filing a claim. Therefore, you need to review that section of your policy often called "Conditions" or "Insured's Duties After a Loss."

3. What information must I give my insurance company?

A copy of any legal documents you receive as a result of an accident, such as a letter from an attorney or a summons and complaint.

A proof of loss, as may be required by the insurance company, describing the date of the loss, how it happened, who was driving, and any other relevant information. If a proof of loss is required, your company could deny your claim if you fail to provide it.

Your company may also ask for other documents related to the claim such as repair bills or estimates, a copy of the police report, or a copy of the vehicle's title or bill of sale.

In some cases, your company can also require you to submit to an examination under oath and produce requested documents. You do have the right to have an attorney present during the examination under oath. If you do not submit to the examination under oath, your company could deny your claim.

4. When will my insurance company contact me and how long do they have to look at my vehicle?

New Jersey insurance regulations require your insurance company to contact you within 10 working days after they have been notified of a loss, or if they intend to exercise their right to inspect the damaged vehicle, they must do so within 7 working days.

Your insurer can only require your vehicle to be made available for inspection at a time and place which is reasonably convenient for you.

5. How long does my insurance company have to settle my claim?

Your insurance company is allowed 30 calendar days to settle your first party claim from the time they receive notice of the loss. However, this time may be extended if the company needs to conduct additional investigation or if you fail to cooperate with them.

The company must provide you with written notice explaining the reason for the delay if the claim settlement process takes longer than 30 days.

6. Will my insurer pay for me to rent a car?

It depends. If your car is stolen, most insurance policies will reimburse you for a stated amount towards the cost of a rental vehicle for a limited time starting 48 hours after the theft, as long as you report the theft to the police and to the insurance company. Check your policy for the exact wording.

For non-theft claims, most policies don't provide coverage for a rental vehicle unless you buy this additional coverage. If another party was responsible for the accident, that party's insurer may be responsible for rental charges. (For more information, see third party claims...)

7. What about storage fees?

If your vehicle is not driveable after an accident and is towed to a storage facility, the storage facility will charge you a daily storage fee. Your insurance company must give you 3 working days notice before they stop paying for storage charges in order to give you time to move the vehicle to someplace where you won't incur storage charges.

8. Who decides whether or not my vehicle can be repaired?

After evaluating the damages to your vehicle, your insurance company has the option of repairing your vehicle, replacing your vehicle, or reimbursing you for the vehicle's actual cash value (ACV). Actual cash value is the amount your vehicle would have sold for on the date of the accident.

Your insurance will elect to replace your vehicle or reimburse you for the ACV in those instances where the vehicle is economically impractical to repair.

A vehicle is considered economically impractical to repair, or a total loss, if the cost to repair the vehicle equals or exceeds the vehicle's ACV on the date of the loss. In many instances an insurance company will total a vehicle if the appraised damages equal 80% of the vehicle's ACV because often, once repairs are begun, additional damages or "hidden damages" are found which would render the vehicle a total loss by definition. (This is sometimes referred to as a "constructive total" loss).

9. Can I choose my own repair shop?

Yes. Provided the repair shop is licensed, your insurer has to try to reach an agreed price with the shop of your choice. If your company cannot reach an "agreed price", they will provide you with the names of licensed shops who can do the repairs for the price the company has determined.

10. Can I ask my insurer to recommend a repair shop?

Yes. At your request, your company must recommend a qualified repair facility convenient to the vehicle's location which will repair the vehicle at the price the company is willing to pay and whose work is guaranteed. Your insurance company further stands behind the repair shop’s guarantee.

11. Does my insurance company have to use new parts to repair my car?

No. The contract of insurance only obligates the insurance company to restore your vehicle to the same condition it was in before the loss. Sometimes this requires the use of original equipment manufacturer (OEM) parts and sometimes after-market parts can be used. After-market parts are parts made by a manufacturer other than the original manufacturer.

If your vehicle is being repaired with newer parts, your company doesn't have to pay for this "betterment". For example, if your vehicle's transmission is five years old and is damaged due to a covered loss, your insurer would only have to replace it with a five year old transmission. If a five year old transmission can't be found, the repair shop could use a new transmission but you'd have to pay the difference between the value of a five-year-old transmission and a new transmission.

12. Do I have to accept non-OEM parts?

No. While New Jersey regulations do permit the use of after-market parts as long as they are warranted by the manufacturer to be of like kind and quality as OEM parts, you don't have to accept them. The final choice is yours but if the insurer wants to use non-OEM parts and you decide to use more expensive OEM parts, you may have to pay the difference in cost.

The regulations also require the insurer to clearly indicate in writing on the appraisal which parts are after-market parts and pay for any modifications necessary.

13. Do I have to pay a deductible?

When you bought your policy, you chose a deductible for your physical damage coverages. This is the amount you are responsible for if a claim occurs. The higher your deductible, the lower the cost of your physical damage coverage. Your insurer will deduct that amount from the settlement of your claim.

Keep in mind that insurance companies consider it to be fraud if the repair shop inflates your repair estimate to help you recover the cost of your deductible.

14. How will the value of my vehicle be calculated to determine if it is a total loss?

Each insurance company is required to select one of three prescribed methods for use in the settlement of all their total loss claims.

The three methods which have been approved by the Commissioner of Banking and Insurance are:

1. Taking the average of the retail values of substantially similar vehicles as listed in the current editions of the "Automobile Red Book" (or "Older Car Red Book") published by Penton Media and the "N.A.D.A. Official Used Car Guide" (or "N.A.D.A. Official Older Car Guide") published by the National Automobile Dealers Used Car Company.

2. Using a quote obtained by the insurer for a substantially similar vehicle available for you to purchase from a dealership within 25 miles of where your car is normally garaged.

3. Utilizing the services of an approved source, including computerized databases that produce fair market values of substantially similar vehicles. At this time Audatex, Mitchell International and CCC are approved for use in determining fair market values.

If your vehicle cannot be valued using any of these three methods because they fail to represent a true cross-section of the market to determine the fair market value of your car, the company is then required to use the best available method and fully explain to you, in writing, how they calculated the amount they are offering you.

In addition to telling you which method is used to value your car, your insurance company must also provide you with an itemized list showing all additions, deductions, and sales tax applicable to your vehicle.

15. Can my insurer deduct for any damage or rust to my vehicle which existed before the loss?

Yes. However, deductions for previous damage or prior condition must be itemized with a specific dollar amount and are limited to the amount by which the resale value of the car is increased by the elimination of the previous damage or correction of the prior condition. In other words, if your car was damaged in a previous accident and you decided not to get it repaired, or if you neglected the condition of your car which resulted in the vehicle sustaining rust, your car would not be worth as much on the open market if you tried to sell it than it would be had you elected to repair the previous damage or maintain the car in good condition. The amount by which the resale value of your car increases by eliminating the previous damage, or correcting the prior condition, is the amount the insurance company can deduct from your total loss settlement.

As New Jersey does not have a law which specifies just how insurers can take deductions for previous damage or prior condition, the example below is provided solely for the purpose of giving you a better understanding of this concept to assist in your negotiations with the insurer.

Example - A quarter panel damaged prior to the covered accident which the insurer estimates will cost $600 to replace may result in the following deductions:

If the vehicle is 1 and 2 years old - $600 deduction for previous damage
If the vehicle is 3 and 4 years old - $450 deduction for previous damageIf the vehicle is 5 through 7 years old - $300 deduction for previous damageIf the vehicle is over 7 years old - $150 deduction for previous damage.

16. I found a car just like mine that costs more than what I got from the insurance company for my old car. What can I do?

Provided you have located a substantially similar vehicle within 30 days from receiving the company's settlement check, your company will have to either:

Pay you the difference between the cost of the car that you found and the amount of the claim settlement.

Negotiate the purchase price of the car that you found.

Locate a substantially similar vehicle within a 25 mile radius of your vehicle’s principle place of garaging which you can purchase at the market value established by the company in their original offer of settlement.

17. Does my insurer have to give me the option to keep my car after they have declared it a total loss?

No. Once they settle a total loss, your insurance company assumes the rights to your car and can dispose of it however they wish including selling it or its parts for salvage. They can, at their discretion, let you keep the car and let you try to salvage it yourself.

If the insurer lets you keep your car, they will deduct its salvage value from your total loss settlement before applying your deductible.

18. If the insurer settles my total loss and lets me keep the car, can I use the settlement money to fix it instead of selling it for salvage?

After the repairs are made, the vehicle must then be presented to the MVC for a special inspection before it can be driven on public roads.

19. Does my insurance company have to pay off my car loan?

No. The insurance policy only requires the company to pay the actual cash value of the vehicle less your deductible. If your car's value is less than the loan, you are still responsible for the difference.

Keep in mind that if your lender is listed as a loss payee on your policy (which is normally the case) the settlement check will be made out to them as well as to you.

20. What if my company and I can't agree on the amount of my loss?

If you and your insurer can't agree on the amount of your physical damage loss either one of you may request an appraisal as explained in your policy. Here is how the appraisal process usually works:

You choose and pay for an appraiser to represent you.

The company will choose and pay for an appraiser to represent them.

The two appraisers will select a neutral third party umpire (for whom you and your company split the cost, if necessary).

Both appraisers will give their estimates for the loss.

If the appraisers can't agree, they will submit their differences to the umpire and a decision by any two of the three is binding.

21. Must I conclude my claim within a certain time frame?

Yes. You must either accept a final settlement or file a lawsuit within the time period specified by the appropriate statute of limitations.

If you fail to accept a final settlement offer or to file a suit before the statutory period runs out, you may jeopardize your right to receive any settlement at all.

22. What else can I do if my insurance company and I can't agree, or if they deny my claim?

You can file an appeal with the insurance company's internal appeals panel. If you are still unsatisfied after the company's internal appeals panel renders its decision, you can request a review of that decision by the Insurance Claims Ombudsman.

You can file a written complaint with:

The Office of the Insurance OmbudsmanNJ Department of Banking and Insurance
20 West State Street
PO Box 472
Trenton NJ 08625-0472
1-800-446-7467E-mail: ombudsman@dobi.state.nj.us

If you have any further questions or would like additional information, you can contact the Department of Banking and Insurance either through the Office of the Insurance Claims Ombudsman at 1-800-446-7467 or the Consumer Inquiry and Response Center (CIRC)at 609-292-7272.

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